title: Vaginal flora changes on Pap smears after insertion of levonorgestrel-releasing intrauterine device.
abstract: BACKGROUND
  The levonorgestrel intrauterine system (LNG-IUS) combines a uterine foreign body and the continuous release of low-dose levonorgestrel for contraception. Its influence on the rate of vulvovaginal infections and flora disturbance is insufficiently known, but important for contraceptive advice in women, especially those who develop recurrent vaginosis or Candida vulvovaginitis.
  
  
  METHODS
  Slides of 286 women who had a Pap smear taken before and 1 to 2 years after placement of a LNG-IUS were blindly reviewed for the presence of abnormal vaginal flora (AVF), bacterial vaginosis (BV), aerobic vaginitis (AV) and Candida vaginitis (CV).
  
  
  RESULTS
  Prior to insertion, there were no differences in vaginal flora abnormalities between women using different kinds of contraception. LNG-IUS users did not have different rates of AVF, BV, AV or CV, but the general risk to develop any infection was increased. Uterine bleeding after insertion did not seem to predict a different flora type.
  
  
  CONCLUSIONS
  We found that Pap smears suggested more vaginal infections after 1 year of LNG-IUS use than prior to insertion of the device.
authors.affiliation: Femicare vzw, Clinical Research for Women, 3300 Tienen, Belgium. gilbert.donders@femicare.net
authors.forename: Gilbert G G
authors.initials: GG
authors.lastname: Donders
authors.forename: Judith
authors.initials: J
authors.lastname: Berger
authors.forename: Hélène
authors.initials: H
authors.lastname: Heuninckx
authors.forename: Gert
authors.initials: G
authors.lastname: Bellen
authors.forename: Ann
authors.initials: A
authors.lastname: Cornelis
mesh_terms: D002175:Candida / Q000302:isolation & purification; D002177:Candidiasis / Q000382:microbiology; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003267:Contraception / Q000009:adverse effects / Q000379:methods*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D005260:Female; D006194:Gardnerella vaginalis / Q000302:isolation & purification; D006801:Humans; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000008:administration & dosage*; D017904:Mobiluncus / Q000302:isolation & purification; D065006:Papanicolaou Test; D010865:Pilot Projects; D012189:Retrospective Studies; D014621:Vagina / Q000187:drug effects* / Q000382:microbiology*; D014626:Vaginal Smears; D014627:Vaginitis / Q000382:microbiology; D016585:Vaginosis, Bacterial / Q000382:microbiology
chemical_list: D003271:Contraceptive Agents, Female; D016912:Levonorgestrel